Post-Autism recounts in close and vivid detail the story of the author’s struggle to analyse and communicate with a pubertal boy who presented with a diagnosis of untreated infantile autism. Marisa Mélega, who was at that time a young and relatively inexperienced analyst, worked with Mário in São Paulo, Brazil, from 1978 to 1982 and during most of that period the case was supervised by Donald Meltzer, who had recently published his pioneering work Explorations in Autism, based on ten years of collaborative endeavour with a group of therapists. At that period the condition of autism was relatively little understood, and psychological therapies undeveloped.

This book is therefore of particular interest from several viewpoints: as a detailed record of autistic features and their manifestations in a teenage child; as an example of the potentialities of distance supervision (for communication was mainly by post, though there were some meetings); historically, as a basis for comparison with our current understanding of the condition and the efficacy of psychoanalytic treatment; and perhaps above all, as an intimate record of the making of a psychoanalyst, by means of a particularly difficult yet highly emotionally stressful relationship with a patient. As Melega writes in her introduction: “I received brilliant lessons from Donald Meltzer that have enlarged my general psychoanalytical capacity to investigate the transference and countertransference … to avoid sticking exclusively to verbalizations, and to search for my own oneiric images during the sessions in order to make analysing Mário possible.”

Reviews and Endorsements

‘This book describes the journey in the late 1970s and early 1980s of a therapist tirelessly struggling to maintain an intimate dialogue with a pubertal boy who presented as a case of untreated infantile autism. At each step Marisa Pelella Mélega questions the efficacy of different approaches and even her conviction about the appropriateness of a psychoanalytic approach. The therapist’s desire is to make contact with the deeply human in the child, breaking through the defensive layer of hardness she runs into time and again. Donald Meltzer supports this adventure and finds in this work inspiration for innovative, interesting ideas. The reader can easily empathize and identify with the therapist in her struggle, and the book gives rise to new ideas and leads to the conviction that a psychoanalytic approach to treating patients who are within the autistic spectrum is not only possible but also highly desirable.’- Lucy Bermann and Dolors Cid, Members of the Grupo Psicoanalitico de Barcelona (Psychoanalytic Group of Barcelona)

‘There is much to admire in this book. It is a pioneering work in Brazil on the topic of the autistic spectrum. It also provides an interesting opportunity to journey backwards in time to a period when work with this type of patient was relatively new, and to compare it with the way things are now. The narrative movingly recounts the detailed texture of the sessions, and shows Marisa Pelella Mélega’s great capacity for the minute discussion of countertransference phenomena. In addition, there is the richness of Donald Meltzer’s supervisions, and despite the distance (as these were mainly conducted by post), the intricate interaction of both analysts in the joint task of working to bring the patient into the world of human relationships and interests.’- Mariza Leite Da Costa, Child and adolescent psychotherapist in Brazil, former member of the Autism Workshop, Tavistock Clinic, and teacher of Infant Observation, Essex University

About the Author(s)

Marisa Pelella Mélega is a psychiatrist and psychoanalyst in private practice, and a Training Analyst and Supervisor at the Brazilian Psychoanalytic Society of São Paulo. She founded the São Paulo Mother-Baby Relationship Study Centre in 1987, receiving accreditation from the Centro Studi Martha Harris, in Rome. She teaches at the Brazilian Institute as a child psychoanalyst, where she chaired the training in child analysis from 1990 to 1996. Her clinical and research interests include applications of the Esther Bick observation model, as in assessment and therapeutic interventions with parents and children. She is the author of Looking and Listening: Work from the São Paulo Mother-Baby Relationship Study Centre; Post-Autism: a Psychoanalytic Narrative, with Donald Meltzer's supervisions; and Eugenio Montale, Poetic Creativity and Psychoanalysis.